Recurrent hematomas following craniotomy for traumatic intracranial mass.
Of 850 patients who underwent craniotomy for evacuation of a traumatic intracranial mass, 59 (6.9%) developed a second hematoma at the operation site, which required a second operation. Compared to those who did not, patients who developed postcraniotomy hematoma (PCH) had a significantly higher incidence of evidence of alcohol intake and preoperative mannitol administration; a higher percentage had a bad outcome. Coagulopathy was frequent in PCH patients. Although three-quarters of the initial hematomas were intradural, 69% of the PCH's were predominantly extradural. The large potential space underlying a craniotomy bone flap may predispose to development of a PCH. Intracranial pressure (ICP) was monitored in 39 of the 59 PCH patients, which allowed earlier detection of the PCH in 22 (56%). In 17 patients, the ICP failed to rise despite clinical deterioration, and detection of the PCH was delayed, significantly worsening the outcome in this group.
Bullock
R
R
Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland.
Hanemann
C O
CO
Murray
L
L
Teasdale
G M
GM
D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery*; D006259:Craniocerebral Trauma / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation